Mosaico Church

Parent First Name

Last Name

Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

If available, Second Parent First Name

Last Name

Phone Number

Child First Name

Last Name

Birthdate

Gender

Allergies

For which days are you registering?

Tuesdays and Thursdays

Wednesdays and Fridays

For which period?

Ages 1 to 5 Spring Semester April 1-May 30th

Ages 1 to 6 Summer Learning Fun June 3rd-August 8th

Ages 1 to 5 2025-2026 August 12th-May 29th

Do you require aftercare? After school care 2pm-3pm

Yes